The Autism "Epidemic"

With current diagnostic rates in the United States sitting at 1 in 150 children (1 in 94 boys), parents and professionals are asking themselves if there is an autism epidemic. Having two children on the autism spectrum myself, I have spent countless hours researching this exact question. Some would argue that environmental triggers, most notably the increase in childhood vaccinations, have led to an increase in autism. Others state that there is no true epidemic but that the expansion of the diagnostic criteria in the Diagnostic and Statistics Manual of Mental Disorders version IV (DSM-IV) for autism and related conditions, along with the inclusion of Asperger's Syndrome in 1994, have led to the dramatic rise. While there is sufficient data to make an adequate conclusion, the conclusion held by scientists and doctors is not usually the most popular conclusion among parents which is causing a rift in the autism community. Many parents do think that there is an epidemic, even though study after study has proven that there is not an actual epidemic but that many other reasons sufficiently explain the increased prevalence of this developmental disorder.

"Autism is a highly variable syndrome that resists easy definition" (Grinker 10). Let's go ahead and define autism for the sake of this essay; "autism is a complex developmental disability that typically appears during the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills" (Autism Society of America). This essay will focus on all autism spectrum disorders (ASDs); diagnoses included under the umbrella of ASDs are autistic disorder, Rett's Disorder, childhood disintegrative disorder, Asperger's Syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS).

Epidemic is defined as "a rapid spread or increase in the occurrence of something" (Dictionary.com). This essay will focus on the fact that there has not been a rapid increase in autism itself, but instead an increase in the number of cases of autism that are being diagnosed. Autism has likely occurred at the current prevalence rate for some time, but due to many factors cases that were once missed, or even misdiagnosed, are now correctly being identified as autism or one of the various ASDs.

Autism was first identified by Leo Kanner in 1938 and his research findings were published in 1943. The first edition of the DSM was released in 1952 and then revised in 1968 (DSM-II), 1980 (DSM-III), 1987 (DSM-III-R), 1994 (DSM-IV), and most recently in 2000 (DSM-IV-TR). In the original DSM there was no mention of autism; instead children with autistic-like symptoms fell under the diagnostic label schizophrenic reaction, childhood type. The DSM-II changed the diagnosis to schizophrenia, childhood type and part of the diagnostic criteria states "The condition may be manifested by autistic, atypical and withdrawn behavior..." (Grinker 111). Finally with the release of the DSM-III in 1980 autism was given its own distinct category; Infantile Autism. Infantile autism had a list of six characteristics and it was mandatory that each of these six conditions were to be present in order for a diagnosis to be made. By 1987 this was changed to Autistic Disorder (AD) which is the name it that is still used today. The diagnostic criteria set forth in the DSM-IV (released in 1994) had a list of 16 possible characteristics of which only half needed to be met. In addition to the broader list of conditions, the DSM-IV had "more inclusive phrasing" (Gernsbacher 55).

This history lesson regarding autism and the DSM clearly points out that over time not only the definition of autism changed, but the diagnostic criteria that an individual needed to meet to receive the diagnosis also changed. As a result of this change in diagnostic criteria, the diagnostic rates for autism and other ASDs has naturally gone up. "Each successive edition of the Diagnostic and Statistical Manual of Mental Disorders--the bible of mental health--has revised the criteria for identifying autism in ways that tend to include more people" (Wallis).

In addition to the expansion of the diagnostic criteria, the increase in knowledge about this disorder, both among professionals and parents, can also partially explain the rise in spectrum diagnoses. It is not uncommon for a professional to diagnose a child with a different condition first; ADHD, Down Syndrome, Tourette's Syndrome, and mental retardation are just a sampling of these conditions that can also be seen alongside autism. These conditions are co-morbid and not mutually exclusive; one diagnosis does not trump the other.

Parents with more knowledge about autism, and the various ways it can manifest in a child, now bring their concerns to the attention of a professional who is likely also more knowledgeable about autism. Instead of stating that the child merely has Down syndrome and the symptoms that concern the parent are a natural result of the Down syndrome, professionals look further and realize that something extra is going on. The child is then diagnosed with both Down syndrome and autism whereas in the past the Down syndrome diagnosis would exclude the need for an autism diagnosis. This increased knowledge also leads to more children being diagnosed who are more mildly affected. Children that were once just considered quirky, shy, or even aggressive may actually be diagnosed with an autism spectrum disorder after a careful evaluation. These are not misdiagnosed cases but merely cases that society explained away to bad parenting. Fine-tuning both the diagnostic criteria, and the increased knowledge of parent and professionals, definitely helps to explain this increase in autism diagnoses.

Another factor in the increased autism prevalence rate is the reporting mandated by school systems under the Individuals with Disabilities Education Act (IDEA) which was first passed by Congress in 1991. IDEA requires school systems to keep an accurate count of all of their students being serviced through special education along with what diagnostic area they were being served. When IDEA was first mandated "use of the autism reporting category was optional (it was required only in subsequent years)" (Gernsbacher 57) so when one looks to the educational increase in autism they are also getting skewed numbers. Often-times schools would complete the IDEA paperwork with a more generic terminology such as developmental delays or an even more specific symptom such as speech-language impairment. These are a few of the main reasons that the scientific community cites to explain the rise in autism diagnoses from 1 in 166 children reported by the Centers for Disease Control and Prevention in 2004 to the 1 in 150 that was reported earlier in 2007.

Advocacy groups that tout this increase in autism cases as being an epidemic will point out that there is clearly an epidemic here in the United States because other countries have not seen similar rises in autism rates. This is also an easy argument to refute. In South Korea, for example, there is a very strong negative stigma associated with children diagnosed with an autism spectrum disorder. To combat this negative stigma many of the children in the urban areas of South Korea are ultimately diagnosed with Reactive Attachment Disorder (RAD), because RAD is considered more socially acceptable. The symptoms of the child don't change, they are autistic. However, because of societal demands they do not receive the autism diagnostic label. Another example would be in tribal Africa. Western medicine is not prevalent in many of the rural and tribal areas of Africa. Parents of children with autism don't traditionally seek a diagnosis from a professional practicing Western medicine and instead seek out traditional medicine and rituals to assist their child.

Accepting that there is no true epidemic is a tough pill to swallow for many parents and even some professionals. As it stands now this increased awareness and natural increase in diagnoses will benefit all in the autism community by the way of increased funding and services. Interventions are the key ingredient needed to help autistic children grow up to be happy, successful, and ultimately independent adults.

Works Cited

American Psychiatric Association. October 14, 2007. < http://www.psych.org/research/dor/dsm/dsm_faqs/faq81301.cfm>.

Autism Society of America. October 14, 2007. .

Centers for Disease Control and Prevention. October 14, 2007. .

Dictionary.com. October 14, 2007. < http://dictionary.reference.com/browse/epidemic>.

Fighting Autism. October 14, 2007. .

Gernsbacher, Morton Ann, Michelle Dawson, and H. Hill Goldsmith. "Three Reasons Not to Believe in an Autism Epidemic." Current Directions in Psychological Science 14.2 (Apr. 2005): 55-58. Academic Search Premier. EBSCO. ASU Library, Tempe, AZ. 14 October 2007. .

Grinker, Roy Richard. Unstrange Minds. New York: Basic Books, 2007.

Wallis, Claudia. "What Autism Epidemic?" Time 169.4 (22 Jan. 2007): 69-69. Military &Government Collection. EBSCO. ASU Library, Tempe, AZ. 14 October 2007. .

Wazana, Ashley M.D.; Bresnahan, Michaeline Ph.D. ; Kline, Jennie Ph.D. "The Autism Epidemic: Fact or Artifact?" Journal of the American Academy of Child & Adolescent Psychiatry. 46.6 (June 2007): 721-730. Academic Search Premier. Ovid. ASU Library, Tempe, AZ. 14 October 2007.